Anda di halaman 1dari 60

CRISIS COUNSELING ..............................................................................


CHAPTER ONE: CRISIS COUNSELING ........................................................................ 2


CHAPTER THREE: PSYCHOLOGICAL DEBRIEFING .............................................. 13

CHAPTER FOUR: GRIEF CRISIS.................................................................................. 17

CHAPTER FIVE: SUICIDE CRISIS ............................................................................... 21

CHAPTER SIX: RAPE CRISIS ....................................................................................... 27

CHAPTER SEVEN: CHILD COUNSELING ................................................................. 32

CHAPTER EIGHT: FAMILY CRISIS ............................................................................ 38

CHAPTER NINE: CRISIS CASE HANDLING .............................................................. 44

CHAPTER TEN: CRISIS INTERVENTION ................................................................. 54



The chapter explains crises counseling, the characteristics of a crisis and the elements of
crisis counseling. The definition of the word crisis is also explained.

Specific objectives

By the end of this chapter the learner should be able to;

(i) Define the term crisis.

(ii) State and explain the characteristics of a crisis.
(iii) Explain the elements of crisis counseling.

Definition of crisis, characteristics of a crisis, elements of crisis counseling.


The word “crisis” in Chinese character means both danger and opportunity. Crisis is a
danger because it threatens to overwhelm the individual or his family, and it may result to
suicide or a psychotic break. It is an opportunity because during times of crisis,
individuals are more receptive to therapeutic influence.

Crisis is a perception of an event or situation as an intolerable difficulty that exceeds the

person’s resources and coping mechanisms. Unless the person obtains relief, the crisis
has the potential to cause severe effective, cognitive and behavioral malfunctioning.

A crisis is an unstable time or state of affairs in which a decisive change is impending,

either one with a distinct possibility of a highly undesirable outcome or one with the
distinct possibility of a highly desirable and extremely positive outcome.

As defined by Caplain (1961) crisis may occur when an individual faces a problem that
he cannot solve. There is a rise in inner tension and a sign of anxiety and inability to
function in extended periods of emotional upsets.

Characteristics of crisis

1. Presence of both danger and opportunity. Crisis is a danger because it can

overwhelm the individual to the extent that serious pathology, including homicide
and suicide may result. Crisis is also an opportunity because the nature of the pain
it induces impels the person to seek help (Aguilera & Messick, 1982). If the

individual takes advantage of the opportunity, the intervention can help plant the
seeds of self-growth and self-realization (Brammer 1985).
2. Complicated symptomology. Crisis is not simple, it is complex and difficult to
understand, and it defies causes and effect description (Brammer, 1985; Kliman
1978). The symptoms that overlie precipitating crisis events become tangles webs
that crisscross all environments of an individual.
3. Seeds of growth and change. In the disequilibrium that accompanies crisis,
anxiety is always present and the discomfort of anxiety provides an impetus for
change (Josonic 1984). Many times the dilemma is that the anxiety must reach the
boiling point before an individual is ready to admit that the problem has gone
beyond control.
4. The absence of panaceas or quick fixes. People in crisis are generally amenable to
help through a variety of forms of intervention, some of which can be described
as brief therapy (Cormier and Hackney, 1987). Many problems of clients
suffering from severe crises stem from the fact that they sought quick fixes in the
first place, usually through a pill. Whereas the ‘fix’ may dampen the dreadful
responses, it does nothing for the instigating stimulus, and therefore the crisis
5. Necessity of choice. Life is a process of interrelated crises and challenges that we
confront or not, deciding to live or not (Carkhuff and Berenson, 1977). In the
realm of crisis, not to choose is a choice, and this choice usually turns out to be
negative and destructive. Choosing to do something at least contains the seed of
growth and allows a person the chance to set goals and formulate a plan to begin
to overcome the dilemma.
6. Universality and idiosyncrasy. Disequilibrium or disorganization accompanies
every crisis, whether universal or indiosyncratic (Janosik, 1984). Crisis is
universal because no one is immune to breakdown, given the right constellation of
circumstances. It is idiosynacratic because what one person may successfully
overcome, another may not, even though the circumstances are virtually the same.


In mental health, terms a crisis is an individual’s reaction to an event situation or stressor.

Crisis counseling is brief and focused on reducing stress, providing support and
improving coping skills.

Crisis intervention is focus on minimizing the stress of the event, providing emotional
support and improving the individuals coping strategies in here and now.

Crisis counseling involves assessment and treatment focuses on the client’s immediate
situation including factors such as safety and immediate needs.


1. Assessing the situation. It involves listening to the client, asking questions and
determining what the individual needs to effectively cope with the crisis during

this time, the crisis counseling provider needs to define the problem while at the
same time acting as the source of acceptance and support. Ensure the client’s
safety both physically and psychologically.
2. Education. During crisis counseling mental health workers often help the client
understand that their reactions are normal but temporary. While the situation may
seem both dire and endless to the person experiencing the crisis the goal is to help
the client see that he/she will eventually return to normal functioning.
3. Offering support. One of the most important elements of crisis counseling
involves offering support, stabilization and resources. Active listening is critical,
as well as offering unconditional acceptance and reassurance offering this kind of
non-judgmental support during a crisis can help reduce stress improve coping.
During the crisis it can be very beneficial for individuals to develop a brief
dependency on supportive people, this relationship helps the individuals become
stronger and more independent.
4. Developing coping skills. Crisis counselors help clients develop coping skills to
deal with the immediate crisis. This might involve helping the client, explore
different solutions to the problem practicing stress reduction techniques and
encouraging the thinking. It’s not just about teaching the skills to the client but
also encouraging the client to make a commitment to continue utilizing these
skills in the future.


1. Life experiences. A whole person has a rich and varied background of life
experiences. Those life experiences serve as a resource for emotional maturity
that, combined with training, enables workers to be stable, consistent and well
integrated not only within the crisis situation but also in their daily lives. An ideal
crisis counselor is one who has experienced life, has learned and grown from
those experiences, and supports those experiences in his or her work through
training knowledge and supervision.
2. Professional skills. A crisis counselor should possess the skills of attentiveness,
accurate listening and responding, congruence between thinking, feeling and
acting therapeutically, reassuring and supporting skills, rudimentary ability to
analyze, synthesize and diagnose, basic assessment and referral skills, ability to
explore alternatives and solve problems.
3. Poise. The nature of crisis intervention is that the worker is often confronted with
shocking and threatening material from clients who are completely out of control.
The most significant help the interventionist can provide at this juncture is to
remain calm, poised and in control. Creating a stable and national atmosphere
provides a model for the client that is conducive to restoring equilibrium to the
4. Creativity and flexibility. Creativity and flexibility are major assets to those
confronted with perplexing and seemingly unsolvable problems.
5. Energy. Functioning in the unknown areas that are characteristic of crisis
intervention requires energy, organization, direction, and systematic action.
Feeling good enough about oneself to tackle perplexing problems day after day

calls for not only an initial desire to do the work but also the ability to take care of
ones physical and psychological needs so that energy level remains high.
6. Quick mental reflexes. Crisis intervention requires more activity and directiveness
than ordinary therapeutic endeavors usually do. Time to reflect and mull over
problem is a rare commodity in crisis intervention. The worker must have fast
mental reflexes to deal with the constantly emerging and changing issue that
occur in the crisis.


The adolescent has a strong need to find and confirm his identity. There is a rapid body
growth equaling that of early childhood but compounded by addition of physical-genital
maturity. Faced with the psychological revolution within himself, the adolescent is also
concerned with consolidating his social roles. He is preoccupied with the different
between what appears to be in the eyes of others and what he believes himself to be; in
searching for a new sense of continuity, some adolescents must refight crises left
unresolved in previous years.

Change that occurs as secondary sex characteristics emerge makes the adolescent self-
conscious and uncomfortable with him/her self and with his friends. Body image change
and the adolescent constantly seeks validation that these physiological changes are
“normal” because he feel different and is dissatisfied with how he thinks he looks.

In this period of fluctuation, half-child and half-adult, the adolescents react with childish
rebellion one day and with adult maturity the next. The adolescent is unpredictable to
him/herself as he/she is to parents and other adults. On the one hand, he seeks freedom
and rebels against authority, on the other hand he does not trust his own sense of
emerging maturity and covertly seeks guidelines from adults. In his struggle for identity
he turns to his peers and adopts their way of doing things for example dressing,
mannerism, vocabulary, code of behavior. There is desperate need to belong, to feel
accepted, loved and wanted. Having achieved a sense of security and acceptance from
peers, the adolescent begins to seek heterosexual involvement. As comfort and
confidence increases, the adolescents progresses to more meaningful and deeper
emotional involvements in one-to-one heterosexual relationships.

Because of conflicts between sexual drives, desires, and the established norms of his
society, this stage can be extremely stressful and again he is faced with indecision and
confusion. Occupational identity also becomes a concern at this time. There are continual
queries by parents and school authorities about career plans for the future. Uncertainties
are compounded when a definite choice cannot be made because of an inability to fully
identify with the adult world of work. Having only observed a participated in fragments
of work situation, the adolescents finds it difficult to commit themselves to the reality of
full time employment and its inherent responsibilities.

Piaget (1963) refers to the cognitive development at this state as formal operations the
period in which the capacity for abstract thinking and complex deductive reasoning

becomes possible. At this time, the goal is “independence”, and in mid adolescence
acceptance of the idea that it is possible to love and at the same time to be angry with
someone is one problem that should be solved. If this stage is successfully negotiated, the
individuals develop a capacity for self-responsibility; failure may lead to a sense of
inadequacy in controlling and competing.

Because of the number and wide variety of stimuli and rapid changes to which
adolescents are exposed, they are in a hazardous situation. A crisis situation may be
compounded by the normal amount of flux characteristic of adolescent development
(Cameroon, 1963, Erickson, 1950, 1959, 1963; Piaget, 1963; Zachry, 1940).


Teenagers especially in early ages do not know how to verbalize the strange, vague
feelings which are taking place deep within them. The young person with serious
emotional problems finds it almost impossible to express him/herself.

Working with the early adolescents in an individual relationship or not impossible;

however, it does need careful structuring of the setting and mood, so that the counseling
session may provide an environment in which the young counselee may express his needs
in a manner and at a speed consistent with his/her level of development. One of the best
means of putting the early adolescents at ease in this kind of situation is through active
relationship; giving him/her activities or materials to occupy his interests and conscious
thoughts so that
 His initial tension and anxiety are lessened.
 A relationship of trust and mutual respect can be established between counselor
and young person.
 A vehicle by which the young person may express his inner conflicts and
confusion is provided.

In an activity relationship, work on the particular project is confined to the time spent by
the youngster in the presence of the counselor. It may involve physical activity such as
hiking across fields, taking pictures or an hour each week spent at the booling alley. It
might involve office activity such as the construction of a model airplane or working in
clay, chalk, plastic, or any other media in which the young person has expressed an



The chapter seeks to explain the various theories of crisis. It will give a brief overview of
theories relevant to both crisis (as a phenomenon) and to crisis intervention an intentional
helping response).

Specific objectives

By the end of the chapter the learner should be able to;

 Explain the three levels of crisis theory.

 Describe how these theories are applicable.

Content of the chapter

Basic crisis theory, expanded crisis theory; psychoanalytic theory, systems theory
adaptation theory, interpersonal theory, applied crisis theory; development crisis,
situational crisis, existential crises, ecosystem theory, erections media impact, systematic
interdependency, a macrosystemic approach.


Janosik (1984), conceptualizes crisis theory on three different levels: Basic crisis theory;
expanded crisis theory and applied crisis theory.

Basic crisis theory

The research writings and teaching of Lindemann (1944, 2956) gave professions and
professionals a new understanding of crisis. He helped caregivers promote crisis
intervention from many sufferers of loss who had no specific pathological diagnosis but
who were exhibiting symptoms that appeared to be pathological.

Linderman’s basic crisis theory and work made a substantive contribution to our
understanding of behaviour in clients whose grief crises were precipitated by loss. He
helped professionals recognize that behavioral responses to crises associated with grief
are normal, temporary and ameable to alleviation through short-term intervention
techniques. Lindermann negates the prevailing perception that clients manifesting crisis
responses should necessarily be treated as abnormal or pathological.

Whereas Lindermann focused mainly on immediate resolution of grief offer loss, Caplan
(1964) expanded Linderman’s construct to the total field of traumatic events. Caplan
viewed crisis as a state resulting from impediments can arise from both developmental

and situational events. Both Lindermann and caplan dealt with crisis intervention
following psychological trausma using an equilibrium/disequilibrium paradigm. The
stages in Lindermann’s paradigm are:

1. Disturbed equilibrium.
2. Brief therapy of grief work.
3. Clients working through the problem or grief.
4. Restoration equilibrium.

Caplan linked lindermann’s concepts and stages to all developmental and situational
events and extended crisis intervention to eliminate the cognitive emotional, and
behavioural distortions that precipitated the psychological trauma in the first place.

The work of both Lindermann and Caplan gave impetus to the use of crisis intervention
strategies in counseling and brief therapy with people manifesting universal human
reactions to traumatic events. Basic crisis theory, following their lead focuses on helping
people in crisis recognize and correct temporary cognitive, emotional, and behavioral
distortions brought on by traumatic events.

All people experience psychological trauma at some time during their lives. Neither
stress nor the emergency conditions of the trauma in themselves constitute crisis. It is
only when the traumatic event is subjectively perceived as a threat to need fulfillment,
safety, or meaningful existence that an individual enters a state of crisis (Caplan 1964). A
crisis is accompanies by temporary disequilibrium and contains potential for human
growth. The resolution of crisis may lead to positive and constructive outcomes such as
self-enhancing coping ability and decreased in negative, self-defeating, dysfunctional

Expanded crisis theory

Expanded crisis theory was developed because basic theory, which depends on a
psychoanalytic approach alone, did not adequately address the social, environmental, and
situational factors that make an event a crisis. As crisis theory and intervention have
expanded, it has become clear that an approach that identifies predisposing factors as the
main or only causal agent fails short of the mark. As crisis theory and intervention have
grown it has become apparent that given the right combination of developmental,
sociological, psychological, environmental, and situational determinants, anyone can fall
victim to transient pathological symptoms. Therefore, expanded crisis theory draws not
only from psychoanalytic but also from general systems adaptation, and interpersonal

 Psychoanalytic theory

Psychoanalytic theory applied to expanded crisis theory, is based on the view that the
disequilibrium that accompanies a person’s crisis can be understood through gaining
access to the individual’s unconscious thoughts and past emotional experiences,

psycholoanalytic theory presupposes that some early childhood fixation is the primary
explanation of why an event becomes a crisis. This theory may be used to help clients
develop insight into the dynamics and causes of their behaviour as the crisis situation acts
upon them.

 Systems theory (Haley, 1973, 1976)

Systems theory is based not so much on what happens within an individual in crisis as on
the interrelationships and interdependence among people and between people and events.

The fundamental concept of systems theory is analogous “to ecological systems in which
all elements are interrelated and in which change at any level of those interrelated parts
will lead to alteration of the total system”

Belkin (1984 adds that this theory “refers to an emotional system, a system of
communication and a system of need fulfillment and request” in which all members
within an intergenerational relationship bring something to bear on the others and each
derives something from the other.

Systems theory represents a turning away from traditional approaches, which focus only
on what is going on within the client, and adopts an interpersonal systems way of
thinking. There is a great value in looking at a crisis in their total social and
environmental settings not simply as one individual being affected in a linear progression
of cause and effect events.

 Adaptational theory

Adaptational theory in our use of term depicts a person’s crisis as being sustained through
maladaptive behavior, negative thoughts and destructive defense mechanisms.
Adaptational crisis theory is based on the premise that the person’s crisis will recede
when these maladaptive coping behaviors are changed to adaptive behaviors.

Breaking the chain of maladjusted functioning means changing to adaptive behavior,

promoting positive thoughts, and constructing defense mechanisms that will help the
person overcome the immobility created by the crisis and more to a positive mode of
functioning. As maladaptive behaviours are learned, to may adaptive behaviours be
learned. Aided by the interventionists, the client may be taught to replace old debilitating
behaviours with new, self-enhancing ones. Such new behaviours may be applied directly
to the context of the crisis in overcoming it. (Cormier & Cormier, 1985).

 Interpersonal theory (Rogers, 1977)

Interpersonal theory is built on many of the dimensions cormier and Hackney (1987)
described as enhancing personal self-esteem: openness, trust, sharing, safety,
unconditional positive regard, accurate empathy and genuineness. The essence of
interpersonal theory is that people cannot sustain a personal state of crisis for very

long if they believe in themselves and in others and have confidence that they can
become self-actualized and overcome the crisis.

When people confer their locus of self-evaluation on others, they become dependant
on others for validation of their being. Therefore as long as a person maintains on
external locus of control, the crisis will persist. The outcome goal in interpersonal
theory is returning the power of self-evaluation to the person. Doing so enables the
person once again to control his/her own destiny and regain the ability to take
whatever action is needed to cope with the crisis situation.


The application of crisis theory requires a flexible approach. Each person and each
crisis situation is different. Thus, crisis workers must view each person and the events
precipitating the crisis as unique. Brammer (1985) characterizes applied crisis theory
as encompassing three domains;

1) Normal development crises

2) Situational crises

3) Existential crises

 Development crises

Development crises are events in the normal flow of human growth and evolvement
whereby a dramatic change or shift occurs that produces abnormal responses. For
example developmental crises may occur in response to the both of a child, graduation
from college, midlife career change or retirement. Development crises are considered
normal; however all persons and all developmental crises are unique and must be
assessed and handled in unique ways.

 Situational crises

A situational crisis emerges with the occurrence of uncommon and extraordinary events
that an individual has no way of forecasting or controlling. Situational crises may follow
such events as automobile accidents, kidnappings, rapes, corporate buyouts and loss of
jobs, and sudden illness and death. The key to differentiating a situational crisis from
other crises is that a situational crisis is random, sudden, shocking, intense and

 Existential crisis

Existential crisis “refers to the inner conflicts and anxieties that accompany important
human issues of purpose, responsibility, independence, freedom and commitment. An
existential crisis might accompany the realization, at age 50, that one chose never to
marry or leave one’s parents’ home, never really made a separate life and now has lost
forever the possibility of being a fully happy and worthwhile person.


We believe that a new theory of crisis intervention is rapidly evolving one we choose to
call an ecosystem theory. Three major components play a part in the evolution of this

 Electronic media impact

First, extensive and extended electronic media coverage-bringing disaster and traumatic
events such as Hurricane, murder and hostage taking in school building and post offices –
has ripple effects that spread for beyond the immediate victims of those terrible events.

These traumatic events morbidly hold our attention and give rise to belief that trouble and
are all around us. We have become a global community through technology, and because
crises make big news, we are given a nightly serving of instocam tragedies that give us
pause to wonder if the next crisis will not come right into our living rooms.

On the positive side, through technology revolution, we are now able to better predict the
cause of natural disorders such as hurricanes, volcanic eruptions, earthquakes, and forest
fires and prepare for them. We also have at our fingertips access to a variety of
information systems that can help us respond quickly and effectively to these disasters
and in many instances avert or mitigate the widespread effects such disasters have on the
total ecology. Through the World Wide Web human services workers can gain immediate
access to vast data and reference banks that can provide up-to-date information and
techniques on how to handle any crisis they may encounter. Further, linkage to the
internet gives us the ability to talk to crisis workers and exchange ideas and information
with them in real time. The expertise of thousands of other therapists is as close as all
computer keyboards.

 Systemic interdependency

We are slowly coming to understand that we are all part of the ecological mainstream of
the world. Disasters such as oil spills affect every one who uses fossil fuels. The rampant
upsurge in drug use, violence, and urban decay affects people of all nations. However,
much we might wish to isolate ourselves from those problems and put off paying the
psychological, social, financial, and environmental costs we cannot.

 A macrosystemic approach

With emergence of crisis intervention as a therapeutic specialty and expanded research

into what happens in the immediate aftermath of a crisis, we have come to understand
that unresolved crises play havoc not only with the client’s personal, social, financial and
environmental resources but also with the total ecological system within which the
individual resides. As a result, institutions that range from individual school buildings to
national service organization to the federal government have and are developing
approaches to confront crises throughout the total ecosystem within which they operate.

Ann ecosystem theory of crisis intervention is based on viewing the total ecology within
which the crisis resides and espouses the notion that major catastrophic events impact and
alter the total ecological framework within which the individual operates. Subsequently,
ecosystem theory proposes that it is not enough to deal only with the emotional trauma
that resides with the survivors of these disasters. Rather, because there is great negative
potential for the total ecosystem, to be permanently damaged and altered as a result of
such disasters, large teams of people with expertise in a variety of human and
environmental specialties are required to be trained as rapid reaction teams to attempt to
restore stability and equilibrium to the environment. This macrosystemic and proactive
intervention approach will be dealt with at length in the last chapter of this book.


This chapter has discussed the theories of crisis.


This chapter seeks to explain the model of psychological debriefing. Its purpose and
function how to set up a critical event debriefing and the phases of a critical debriefing.


By the end of this chapter the leaner should be able to:-

 Describe a brief history of psychological debriefing.

 State the purpose of psychological debriefing.

 Explain the functions of psychological debriefing.

 Describe the setting up of a critical event debriefing.

 Explain the phases of a critical event debriefing.


The model was developed by Dr. J. T Mitchell in 1983 to mitigate the stress among
emergency first responders. Over the years, it has come to be regarded as psychological
first aid and is now widely used with survivors and providers of disaster related services
in the wide range of setting.

Debriefing has become a genetic term applied to a structured process that helps survivors
understand and manage intense emotions, identify effective coping strategies and receive
support from peers.


Stress debriefing is not therapy or counseling, its purpose is to:

 Quickly restore and enhance unit cohesion and effectiveness.

 Reduce short term emotional and physical distress.

 Prevent long-term distress and “burnout”.

Critical incident debriefing is basic. It’s a wise preventive maintenance for the mind. It
simply is the psychological first aid.


 Reconstruct (relive) the event together in a secure setting and to get a clear picture
of what actually happened.

 Resolve misperceptions and misunderstanding

 Identify, share and validate the intense feelings experienced during and since the

 Prepare everyone to recognize and resolve any emotional and physical aftereffects

 Enhance the individual’s ability to help themselves and others effectively.

 Encourage and inform where people can get help if needed.

 Prepare the unit to face future disasters.

 Improve communication within the unit, family, work place, etc


 Who should attend the critical incident debriefing?

The critical incident debriefing should be attended by people who have experienced the
same critical event. It should include people who work together or know each other. It
may include family, friends and strangers drawn in the incident by chance. The
debriefing normally include only those directly involved in the incident.

 Who should lead a critical incident debriefing team?

A critical incident debriefing team is led by a specialized trained team. The team may
include; mental health workers, physicians, nurses medics, dentists, chaplains and
chaplain assistants. The team has a leader and an assistant, with more assistants for a
group with more than 25 people.

 When should a critical incident debriefing be done?

A critical incident debriefing is best done 8 to 72 hours after the event. But it’s better to
have one week after the event than never. The debriefing should be expected to run for 2-
3 hours, depending on the number involved and the complexity of the critical incident.
Debriefing should be done when everyone involved has had enough rest.

 Where should a critical incident debriefing take place

A critical incident debriefing should take place in a relatively safe area, quiet, away from
distraction, an emotionally neutral place which is well ventilated, well lit and sheltered
from the elements.


The procedure for critical incident debriefing has seven phases which should be followed


The debriefing leader or the facilitator begins by briefly explaining the purpose of the
debriefing process. Attendees are reassured for the first time that the wide variety of
symptoms that they may be experiencing are normal reactions by normal people to an
abnormal event. During the first phase the debriefing team is introduced and the ground
rules are established.

 Confidentiality is maintained.

 You do not have to speak but you are encouraged to do so.

 All personnel have equal status during the debriefing.

 Speak only for yourself.

 No breaks are taken during the debriefing. If an attendee must leave a team
member will leave with him/her to ensure everything is ok.

 Attendees are encouraged to ask questions during the debriefing.

 Team members will be available at the close of the debriefing to talk with
attendees individually during the refreshment time.

Phase 2: Fact phase

Each person explains what happened during the traumatic event from his/her perspective.
The details and varying perspectives presented during this phase recreate the event for
everyone. This provides the easiest and least threatening way for the attendees to begin
discussing the event.

Phase 3: Thought phase

Attendees are asked to describe their initial thoughts at the time of the incident. This
phase begins to elicit more personal aspects of the event for the participants and starts the
transition to a more emotional level.

Phase 4: Reaction phase

During this phase, the attendees address what, for them, was the worst part of the incident.
Emotional responses that may have started in the thought phase usually become
intensified. Typical responses are crying, anger and expressions of frustration and guilt.

Phase 5: Symptom phase

It provides a transition from a predominately emotional level of processing back to a

more cognitive level. Here, the attendees describe their physical, cognitive behavioral and
emotional reactions.

Phase 6: Teaching phase

The debriefing team describes in details the four clusters of stress symptoms commonly
experienced by individuals subsequent to a traumatic event. Attendees are reminded that
these are normal reactions by normal people to an abnormal event. They are reassured
that with the passage of time their symptoms will very likely taper off. Verbal and written
instructions are distributed describing stress reduction techniques. Lists of mental health
providers (all of whom have the requisites specialized training and experience in
traumatic stress)are provided for attendees who may desire further help. Attendees are
now back at a cognitive level.

Phase 7: Re-entry phase

This phase brings debriefing to an end. Time is allowed for one last comment or closing
statement by each attendee and team member. Refreshments are made available and
attendees are encouraged to stay and chat with the team and one another.

The socialization at the end of the recently phase provides the attendess a transition
between the debriefing process and the resumption of their individual lives. Before the
debriefing team returns to their own homes or work, it is vital that they themselves be
debriefed. In this process the team discusses what went well, what could and should be
done differently and how individually they are coping with the emotions stirred by the


This chapter explains the meaning of grief and the process of briefing and the appropriate
intervention for the grief crisis.

Specific objectives

By the end of this chapter, the learner should be able to;-

(i) Define the term grief.

(ii) Explain the process of grieving.

(iii) Explain the interventions for a grief crisis.


Death is a universal phenomenon; it has ominous presence in that it is realistic and

inescapable. Since every human being will at some time b e subject to death, it seems that
death is most significant. Much is unknown about the process of death and human beings
are noted for their fear of the unknown. This fear may be prototype of human anxiety.
Anxiety relates to the fact that each person is powerless; be/she may postpone death, may
lessen its physical pain, may rationalize it away or deny its very existence, but there is no
escape from it, and so the fight for self-preservation is inevitably lost.


Grief is the natural expected reaction to a loss, it is a process of experiencing

psychological social and physical reactions to our perception of loss.

Family reaction to the death of a loved one must produce an active expression of feeling
in the normal course of events. Omission of such a reaction is to be considered as much a
variation from the normal as is an excess in time and intensity. Unmanifested grief will
be found expressed in some way or another, each new loss can cause grief for the current
loss as well as reactivate the grieving process of previous episodes.

Phases of mourning/Griefing process by Lindemann (1944)

Phase 1:Shock and disbelief

There is a focus on the original object with symptoms of somatic distress occurring in
waves, lasting from 20 minutes to an hour, at a time, a feeling of tightness in the throat,
choking with shortness of breath need for signing, an empty feeling in the abdomen and
lack of muscular power. There is commonly a slight sense of unreality, a feeling of

increased emotional distance from other people, and an intense preoccupation with the
image of the deceased.

There is a strong pre-occupation with feelings of guilt, and the bereaved searches the time
before death for evidence of failure to do right by the lost one, accusing him/her of
negligence and exaggerating minor omissions.

Phase II: Developing awareness

Disorganization of personality occurs in this phase, accompanies by pain and despair

because of the persistent and insatiable nature of yearning for the lost object. There is
weeping and a feeling of helplessness and possible identification with the deceased.

Phase III: Resolving the loss

Resolution of the loss completes the work of mourning. A reorganization takes place with
emancipation from the image of the lost object and new object relationship is formed.
Engel (1964) states that the clearest evidence that mourning or grieving is successful
completed is the ability to remember completely and realistically the pleasure and
disappointments of the lost relationship.

There are however some individuals who are unable to express overtly these urges to
recover the lost object. This is called pathological mourning. When all reactions are
repressed, they will influence behavior in a strange and distorted way. For example a
schizophrenic person’s reaction to the death of a significant person may be laughter.

The Kubler-Ross Model

In her five-stage model, Elizabeth Kubler-Ross (1969) outlines the human reactions or
responses people experience as they attempt to cope with their own imminent deaths. Her
concepts have also been applied to the process of grief and bereavement following most
personal losses. The model is a general conceptual framework that does not purport to be
applicable in every detail to every patient. It was developed for the purpose of providing
ways for dying patients to teach caregivers and families how patients feel and what they

Stage 1: Denial and isolation

The typical response to the first awareness of one’s own terminal condition may be
something like “No, it cannot be me. There must be a mistake. This is simply not true.”
Kubler-Ross (1969) regards initial denial as a healthy way of coping with the painful and
uncomfortable news. During this stage the patient may generate a temporary protective
and denial system and isolate him/herself from information or persons that may confirm
the terminal condition or the patient may become energetic in garnering proof and
support from others that death is not going to occur.

Stage 2: Anger

The second stage is characterized by “why me” pattern. Persons in this stage cannot
continue the myth of denial, so they may exhibit hostility, rage, envy, and resentment in
addition to anger. Kubler-Ross reports that families and staffs find it quite difficult to
deal with people during their anger stage. The patient’s anger is normal adaptation. It is a
desperate attempt to gain attention, to demand respect and understanding, and to establish
some small measure of control. The patient’s anger should not be taken personally by
staff or family members. The expressions of anger and hostility appears to be typical
ways that patients use to try to cry out for love and acceptance.

Stage 3: Bargaining

During the third stage, patients bargain with physicians or with God for an extension of
life, one more chance, or time to do one more thing. This is another period of self-
delusion, hoping to be rewarded for promises of good behavior or good deeds. It is a
normal attempt to postpone death. A sensitive caregiver should listen to the concerns that
underlie the bargain. The patient may need to deal with guilt or other hidden emotions.

Stage 4: Depression

Whenever the medical condition, the physical proof, bodily appearance and evidence of
the senses force the patient personally to admit that the prognosis is indeed terminal, a
sense of loss ensues. Most patients are confronted with many loses as a result of
impeding death: career, money, loved ones, and possessions, in addition to life itself. It is
normal for depression to set in Kubler-Ross identifies two kinds of depression in the
terminally ill.

(i) Reactive depression

(ii) Preparatory depression.

The first is a reaction to the irrevocable loss, the second is an inner emotional preparation
to give up everything. Patients in preparatory depression should be responded to with
love, caring and empathy, using few or no words. Attempts by caregivers to cheer the
patient up will only interfere with the persons preparatory grieving.

Stage 5: Acceptance

Patients who have traveled through the previous four stages may reach the point at which
they are tired. Weak, finished with their morning, reconciled to their loss, and acceptant
of their situation. This stage is characterized by a quiet, peaceful resignation. It is not a
happy stage. It is a time in which patients draw into themselves. Patients do not need
conversation or large crowds. Family members and caregivers should show love and
support by simply being present, sitting in silence, holding the patients hand or calmly
responding to the patients needs or requests. Patients in this stage should be provided
with treatment to make their lives as pain-free and comfortable as possible.

There may be a delayed reaction or an excessive reaction; or the grief reaction may take
the form of a straight agitated d expression with accompanying tension, agitation,
insomnia, feelings of worthlessness bitter self-accusation, and obvious need for
punishment. Individuals reacting in this way may be dangerously suicidal.

Paper management of grief reactions may prevent prolonged and serious alterations in an
individual’s social adjustment. The essential task is that of sharing and understanding the
individual’s grief work. Comfort alone does not provide adequate assistance. He must
accept the pain of the bereavement. He has to review his relationships with the deceased.
He will have to express his sorrow and sense of loss. He must accept the destruction of a
part of his personality before he can organize it afresh toward a new object or goal.
Although they are unwelcome, such phases are a necessary part of life (Lindemann,
1944). If people are unable to resolve their feelings about the loss.

It hinders their ability to accomplish their developmental tasks. This calls for a
counseling intervention to assist the client resolve their feelings successfully about loss.
The goals for therapy will be;

 To increase the reality of the loss as much as possible.

 To help the client deal with latent or expressed affects.

 Help the client overcome various impediments to readjustment after the loss.

 To encourage the client to say an appropriate goodbye and feel comfortable

investing back into life.


When a client who has not fully resolved his feelings about loss comes for therapy. The
therapist should allow him to say his symptoms, explain the relationship she had with the
deceased and how the death has impacted to him/her, and what has been happening since
the deceased passed on. Ask the client how he/she has been coping with stress in the past.

The goal of intervention is to help the client gain an intellectual understanding of his


According to Fujimur and associates (1985), two different approaches have been
advanced to explain suicide behaviours: Freud’s psychodynamics approach (Allen, 1977)
and Durken’s (1951) sociological approach. In the psychodynamic view, suicide is
triggered by an intrapsychic conflict that emerges when a person experiences greater
psychological stress. Sometimes such stress emerges either as regression to a more
primitive ego state or as inhibition of one’s hostility towards other persons or towards
society so that one’s hostility towards other persons or towards society so that ones
aggressive feelings are turned inward toward the self. In extreme cases, self-destruction
or self-punishment is chosen over urges to lash out at others.

In Durnkheim’s approach, societal pressures and influences are major determinants of

suicidal behavior. Dunkheim (1951) identified three types of suicide: egoistic, anomic
and altruistic.

Egoistic suicide is related to one’s lack of integration or identification with a group.

Anomic suicide arises from perceived or real breakdown in the norms of society.

Altruistic suicide is related to perceived on real social solidarity such as the traditional
Japanese hara-kiri or the episodes of suicidal attacks by Middle East extremist groups.

A fourth type of suicide identified by Fujimara and associates (1985) is dying with
dignity. This type of suicide is typified by a person’s choosing death in the face of an
incurable illness.



This chapter will cover the concepts of suicide. It seeks to explain the reasons that people
have for suicide, the symptoms of a suicidal individual assessment of suicide potential
and the interventions to suicide crisis.

Specific objectives

By the end of the chapter, the learner should be able to:

 Explain the three primary motivators to suicide or suicidal behavior.

 Explain the assessment for suicidal behaviours

 State and explain the major symptoms of a suicidal individual.

 Explain how to identify resources or helpful people to help the suicidal individual.

Suicidal behaviours can usually be related to three primary motivators.

 Loss of communication.

 Ambivalence about life and death.

 The effect of suicidal behavior on significant others.


Usually, suicidal reactions are associated with feelings of hopelessness and helplessness
often related to the separation or loss of a significant or valued relationships suicidal
behavior can best be understood as an expression of intense feelings when other forms of
expressions have failed. A suicidal person is driven to this act because he feels unable to
cop with a problem and believes that others are not responding to his needs. The suicidal
behavior becomes a pressed verbally or by action. Either directly or indirect, the
communication is frequently aimed at a specific person – the significant other. An
indirect communication possess the problem of recognizing the intent of the disguised
message and understanding its real content.


The general explanation for an incomplete or partially effective suicidal act is that the
individual is filled with contradictory feelings about living and dying. This state is terms

 Ambivalence is a universal human trait. We all have it at times, and it is not a

weakness. Everyone experiences ambivalence over decisions at one time or
another. In choosing a career, a spouse or a place to live, in making the decision
of whether to live or die, one would expect to find even more than the normal
amount of ambivalence. This psychological characteristic accounts for the
sometimes puzzling fact that a person will take a lethal or near-lethal action and
then counter balance it with some provision for rescue. The very fact that every
person is divided within himself over decisions provides the chance for successful
intervention with a suicidal patient. By making use of the patients wish to live, his
“cry for help”, suicide may be averted. Every statement or ideation of the wish to
die should be taken seriously and explores with the individual.


Suicidal behavior can further be understood in terms of its effect on those receiving the
communication. A suicidal attempt may arouse feelings of sympathy, anxiety, anger or
hostility on the part of the individual’s family or friends and therefore serve to manipulate
relationships. Therapists may also experience similar feelings unless they counteract
those reactions therapists musts resist the desire to be omnipotent.

Many suicidal situations will arouse feelings of anxiety and self doubt about the
therapists own ability to handle situations of this type. Moderate level of anxiety is
appropriate but too much may seriously hamper the effort to help. Already feeling
helpless and lost, the suicidal person who perceives excessive anxiety may lose hope of
being helped and may bluntly state so.


Before considering the factors that influence the probability of suicide, the therapist
should consider his own attitudes towards suicide and death because they definitely affect
how one will function with patients. Death is a process and is a part of life and living.

A therapist must be sensitive to his own thoughts about death and suicide, and regardless
of personal attitudes, he must avoid any moralistic judgments about what has happened.
The professional point of view must be, that death is to be prevented if possible. From the
first conversation with a suicidal individual, a therapist immediately assumes some
responsibility for preventing the suicide.

In working out some plans for prevention the therapist must first determine the
individual’s suicidal potential, that is, the degree of probability that the person will try to
kill himself in the immediate or near future.

Assessment of suicidal potential depends on obtaining detailed information about the

patient in each of the following categories.

 Age and sex

Statistics indicate that women attempt suicide more than men but men commit suicide
more than women. Currently this trend is changing as women are beginning to feel the
same stresses in their “equal opportunity” position as men feel. It is also known that rates
for completed suicide rises with increasing age. Within this framework, age and sex offer
a general, though by no means clear-cut basis for evaluating suicidal potential.

 Suicidal plan

How an individual plans to take his life is one of the most significant criteria in assessing
potentiality. The following three elements are to be considered;

(i) Is it a relatively lethal method?

An individual who intends to commit suicide with a gun or by jumping from a tall
building is a far greater risk than someone who plans to take some pills or cut his/her
wrist. Since the later methods are amenable to treatment or resuscination, they are less
lethal then the irrevocable consequence of putting a gun to one’s head.

(ii) Does the individual have the means available?

It must be determined if the method of suicide the individual has considered is in fact
available to him. An actual threat to use a gun, if the person has one is obviously more
serious than same without a gun.

(iii) Is the suicide plan specific?

Can the individual tell exactly when he plans to do it. If he has spent time thinking out
details and specific preparations for his death his suicidal risk is greatly increase. When a
patient’s plan is obviously confused or unrealistic one should consider the possibility of
an underlying psychiatric problem.

A psychotic person with the idea of suicide is a particularly high risk because he may
make bizarre attempt based on his distorted thoughts.

Always find out if a person has past history of any emotions disorder and whether he has
ever been hospitalized or received other mental health care.


Find out about any stressful event that may have precipitated the suicidal behavior. The
most common precipitating stresses are losses, death of a loved one, divorce or separation,
loss of a job, money, prestige or status, loss of health through illness, surgery or accident
and loss of esteem or prestige because of possible prosecution or criminal involvement.
Always investigate any sudden change in the individual life situation. Stress should be
evaluated from the individual’s point of view rather than from society’s point of view.
The relationship between stress and symptoms is useful in evaluating prognosis.


The most important suicidal symptom relate to depression. Typical symptoms of severe
depression include: loss of appetite, weight loss, inability to sleep, loss of interest, social
withdrawal, apathy and despondency, severe feelings of hopelessness and helplessness
and a general attitude of physical and emotional exhaustion. Other persons may exhibit
agitation through such symptoms as tension, anxiety guilt, shame, poor impulse control
or feelings of range, anger, hostility or revenge.

Alcoholics, homosexuals and all substance abusers tend to be high suicidal risk. Suicidal
symptoms may also occur with psychotic states. The patient may have delusions,
hallucinations, distorted sensory impressions, loss of contact with reality, disorientation
or highly unusual ideas and experiences.



The patient’s environmental resources are often crucial in deciding how you will manage
the immediate problem. Who are his situational support? Find out who can be used to
support him through this traumatic time. To whom does he feel close? If the patient is
already wider the care of therapist, try to contact him.

The choice of various resources is sometimes affected by the fact that the patient and the
family may try to keep the suicidal situation a secret, even to the point of denying its
existence. As a general rule, this attempt at secrecy and denial must be counteracted by
dealing with the suicidal situation openly and frankly. It is better if the responsibility for a
suicidal patient is shared by as many people as possible. This combined effort provides
the patient with a feeling that he lacks; that others are interested in him, care for him and
are ready to help him.

When there are no apparent source of help or support or if the available resource has been
exhausted, or family and friends have turned away from the individual, the therapist may
be the person’s only situational support, his link to survival.


It is important to know how the individual has functioned in the past under stress. Has his
style of life been stable or unstable? Is the suicidal behavior chronic or acute?

The stable individual will describe a consistent work record, sound marital and family
relationships and no history of previous suicidal behavior. Unstable individual may have
had severe character disorder, borderline psychotic behavior and repeated difficulties
with major situations such as interpersonal relationships or employment.

A suicidal person responding to acute stress, such as the death or loss of someone he
loves, bad new, or loss of a job, which has pushed him into unwanted and unfamiliar
status presents a special concern. The risk of early suicide among this group is high;
however the opportunity for successful therapeutic intervention is greater.

Individuals with a history of repeated attempts of self destruction may be helped through
an emergency, but the suicidal danger can be expected to return at a later date. If a person
has made serious attempts of suicide in the past, his current suicidal situation should be
considered more dangerous.

Acute suicidal behavior may be found either in a stable or unstable personality, however
chronic suicidal behavior may be found only in an unstable person.

In dealing with a stable person in a suicidal situation, you should be highly responsible
and active. With unstable person you need to be slower and more thoughtful, reminding

the patient that he has withstood similar stresses in the past. Your main goal will be to
help him/her through this period and assist him in reconstituting an interpersonal
relationship with a stable person or resource.


The communication aspects of suicidal behavior have great importance in the evaluation
and assessment process. The most important question is whether or not communication
still exists between the suicidal individual and his significant others.

When communication with the suicidal patient is completely severed, it indicates that he
has lost hope in any possibility of rescue. The suicidal person may communicate verbally
or non-verbally. A suicidal person who communicates non-verbally and indirectly makes
it difficult for the recipient of the communication to recognize or understand the suicidal
intent of these communication. This type of communication in itself implies lack of
clarity in the interchange between the suicidal person and others. It raises a danger that
the individual may “act out” his suicidal impulses. The primary goal is to open up and
clarify communication among everyone involved in the situation.

The patient’s communication may be direct towards one or more signifant persons within
his environment. He/she may express hostility, accuse or blame others or he may demand
openly or subtly that others change their behavior and feelings. His communication may
express feelings of guilt, inadequacy, and worthlessness or indicate strong anxiety and


When the communication is directed to a specific person, the reaction of the recipient
becomes an important factor in evaluating suicidal danger. One must decide if the
significant others can be an important resource for rescue. If he is best regarded as non-
helpful or if he might even be injurious to the patient.

A helpful reaction from the significant others is one in which the other person recognizes
the communication, is aware of the problem and seeks help for the individual. This
indicates to the patient that his communications are being heard and that someone is
doing something to provide help.

A non helpful reaction from the significant others is where the other person rejects the
patient or denies the suicidal behavior itself by withdrawing both psychologically and
physically from continued communication. In other situations the significant other may
helpless, indecisive or ambivalent, indicating that he does not know what the next step is
and has given up. This reactions give the suicidal individual a feeling that aid is not
available from a previously dependable source and this will increase the patient’s own


This chapter will focus on rape crisis. It will explain several definitions of rape, how
rapists prepare for rape, and emotional reactions to rape. How potential rape victims can
avoid situations that could lead them to being raped and rape crisis intervention.


By the end of this chapter, the learner should be able to:

 Define rape

 Explain the emotional reactions to rape.

 Describe the stages theta a rapist take before the eventual action of rape.

 Explain the various ways that women can avoid to be raped.

 Explain the interventions to rape crisis.


Definitions of rape, steps taken by rapist before rape, emotional reaction to rape, rape
crisis intervention.


Rape is defined differently by various individuals.

McDonald (1971) it is forcible carnal knowledge. Amir (1971) it is unlawful carnal

knowledge. McDonald (1971:75) against the will or without the consent of the victim.

In this context, we define rape as forcible carnal knowledge of a woman without consent
and against her will. Rape although an overtly sexual not is properly considered an act of
violence with sex utilized as the weapon.

Viewing the victim of rape as a victim of violence might assist in a more objective and
non judgmental approach to the victim. A rape victim is a victim of medical and cultural
myths. The medical myth insists that a healthy adult woman cannot be forcibly raped
with full penetration of the vigina unless she actively cooperates (Amir 1974).

The cultural myth insists that whatever a man does to a woman she provokes (McDonald,
1971:74). The low esteem that society in general holds for women is reflected in both the
medical and the cultural myths.


The victim’s emotional reactions to rape have been classified into phases by McDonald
and by Burgess and Holmstorm. McDonald (1971), classifies the emotional reaction of
victims into:-

Phase 1: Acute reaction

Phase 2: Outward adjustment

Phase 3: Integration and resolution

Burgess and Holmstrom (1974) classify the rape trauma syndrome into;

 Acute phase; disorganization

 Long term process; re-organization

McDonald’s “acute reaction” and Burgess and Holmstrom’s “acute phase” are very
similar. The victim is seen in a disorganized, emotionally active state weeping, distraught,
unable to think clearly or conversely as emotionally contained with only occasional signs
of emotional pressure such as inappropriate smiling and increased motor activity.

McDonald’s “outward adjustment phase is described as a period where the victim goes
through a denial of the emotional impact of the rape. She goes back to work, restores her
social life, rejects any attempts at assisting her and attempts to carry on as if nothing had

The long-term process according to Burgess and Holmstrom seems to contain elements of
phase 2 and phase 3 of McDonald. The emphasis in both studies is on the necessity of
emotional confrontation with the experience, change in life space because of the trauma,
the resultant dreams and deterioration of sexual relationships.

Personal and psychological factors typical to female who is assaulted tend to affect their
responses to rape and their recovery process (Amir, 1971: Benedict 1985) Williams and
Holmes , 1981). This factors include.

 Fear for her life

 May respond by exhibiting no emotions-appearing unaffected.

 Feels humiliated, demeaned and degraded.

 May suffer immediate physical and psychological injury as well as long-term


 May experience impaired sexual functioning.

 May blame herself and feel guilty.

 May experience difficulty relating to and trusting others-especially men.

 May experience fantasies, day dreams and nightmares-vividly relicng the assault
or additional encounters with assailant – or may have mental images or series of

 May feel intense anger or hatred towards the assailant.

 Will never be the same, even thought most survivors over time, develop ways to
re cover, cope, and go on with their lives.

 May be fearful of going to the police or a rape crisis centre.

 May be reluctant to discuss the assault with members of her family, friends and
others because of the risk of rejection and embarrassment.

Crisis intervention is an ideal model for use with rape victims. Rape is sudden,
overwhelming experience for which the usual coping mechanism probably is inadequate.
The victim needs an opportunity for emotional catharsis, reality testing for self-blame,
active support on a short term basis and someone who will assist in identifying the
situational support available.

There are three basic types of rape. The first involving persons who know one another,
the second type is gang rape in which two or more men, usually young men rape one
woman. Third type stranger-to-stranger rape. The third typed is feared most by women
and it is the type of rape that follows an identifiable pattern.

Stages/steps taken by rapists

First a potential rapist looks for a woman who is vulnerable to attack . Rapist often select
their victims long before they approach them and they usually are very consistent in how
they do it. A woman’s first act of resistance should be to refuse to help or helped by
strange men.

After finding a vulnerable target, the rapist proceeds to test if the victim can be
intimidated. The safest stance for a woman alone either on the street or in her home is to
be aloof and unfriendly.

In the third, or “threat” stage of rape, the rapist tells his victim what he wants from her
and what he will do to her if she refuses to cooperate. Most important he tells her what
reward she will receive if she submits.

The final stage of rape is the sexual transaction itself. Viginal intercourse occurs in less
than half of rape victims-anal intercourse is common. In this stage we see the rapists,

fantasy life in full bloom. Here he imprints his unique personality on the crime. Some
rapists will create a false identity and describe a nonexistent person to the victim; others
will reveal their split personalities by telling the victim “it isn’t me doing this” or “I can’t
help it”.

Personal and psychological factors unique to men affects both their decision to assault
and the way the assault is carried out;.(Amir, 1971; Growth and Birnbaum, 1979;
Williams and Holmes, 1981). This factors include;

 The male offender acts in a hostile, aggressive, and domineering manner, even
though he often feels weak, inadequate, threatened and dependant.

 He believes he should act strong, courageous and manly.

 He lacks the skills to make his point in society.

 He may be angry-the angry rapist is likely to use more violent and force than is
needed to compel the individual to submit and is likely to threatened, beat, and
revile the person.

 He may need to exercise power-the power rapist is likely to use the assault
situation to prove to himself and to the person that he is powerful omnipotent, and
in total control.

 He may show sadistic pattern – the sadistic rapist frequently uses extreme
violence and often mutilates or murders the individual. Rapists fall in two
categories, one type include those who are usually victims of ego splits. They are
married, young, employed and living a life that you could not describe as
typically of a person who is mentally ill. However, their family is disturbed; they
cannot relate successfully to their wives or parents and as youngsters they had
problems with older sister’s cousins or aunt.

The other type of rapists is a predator often he is a man who goes into a place to rob it. In
the course of the crime, he enters a bedroom where he finds a lone woman sleeping, on
the spur of the moment he decides to rape her. These men are out to exploit or manipulate

Most rapists can neither admit nor express the fact that they are a menace to society.
They tenaciously insist that women encourage and enjoy sexual assault.


When a rape victim is brought for counseling, the therapist should first carry out
situational assessment. It involves listening actively to the client and asking questions
appropriately. The therapist should allow the client to narrate what happened and how it
happened. The therapist should offer support and allow the client to express all her

feelings. Most women tend to blame themselves for not having fought back or resisted
more and they feel dirty and filthy.

The therapist should then refer the client to the hospital if there are any physical harm and
to determine the presence of the spermatozoa in the vigina, and then help the client report
the case to the police. After which the client should return to the therapist to continue her
mental catharsis. If possible the therapist should avail someone to accompany the client
to the hospital and to the police post.

When the client returns from the hospital and from the police post.. The therapist should
help her to review what happened at the hospital and with the police. The therapist should
help the client identify a relative or a close friend that she can put up with until she
stabilizes. If the client has a lover, a fiancé or a husband, the therapist should help the
client explain to him what happened. The therapist, if necessary should have a session
with the partner to prepare him to accept the victim and help him understand that it
wasn’t the victims fault. The therapist should allow the partner to ventilate his feelings of
pity and anger and any other feelings.

The therapist should facilitate the meeting of the client and the partner and have a few
joint sessions with them.


Since rape is so emotionally traumatic, the client should be treated as an emergency

situation by the therapist. The sooner intervention begins with a rape victim, the less
psychological damage will occur.

Most women are totally unprepared for rape; therefore it is a new traumatic experience to
cope with and previous defense mechanisms are usually ineffective to resolve the crisis.


This chapter explains the various crisis that a child encounters as they pass through
different stages of development. Child counseling is also explained and the major
methods of child counseling.

Specific objectives

By the end of the chapter, the learner should be able to;

 Explain the various developmental stages that children go through.

 Explain the crisis faced on various stages.

 Explain the importance of child counseling.

 State and explain the major methods of child counseling.


Childhood crisis; infancy and early childhood, pre-school, pre-puberty, child counseling;
play therapy, Art therapy.



During the first year of life, the infant depends on his/her material figure and must learn
to trust the mother and must also be able to develop confidence in the sameness and
continuity of his environment and to internalize it through his developing tactile,
auditory, olfactory, and visual senses. Deprivation in any one or a combination of these
senses could lead to maladaptive response patterns affecting his biopsychosocial

During infancy the mouth is the primary organ of gratification and exploration; feeding
becomes an important aspect of meeting needs. This is controlled by someone else,
usually the mother, and her consistentency in meeting her infant’s, needs for gratification
is the beginning of his development of trust in his environment.

Environmental consistency and stimulation are important for cognitive and effective
growth. The infant usually becomes aware of his mother as a person by 9 months.

Piaget (1963) describes the infant’s development of intelligent behavior in this stage as
sensorimotor. During the first year the reflex patterns he was born with are repeated and
strengthened with practice. These can be activated by nonspecific stimuli in the

environment; after being activated a number of times the response becomes spontaneous
without further external stimulation. These primary reflex action become coordinated into
new actions.

By the end of the first year the stage of purposeful behaviour is needed and exploration of
further boundaries of the environment is begun. Motor action have gradually become
internalized as sensory experiences and related mental activities. By the end of the second
year there is a functional understanding of play, imitation, causality objects, space and
time. By the age of 2 years a child can truly imitate behaviour as eating, sleeping,
washing himself and walking.

If the child does not develop the beginnings of trust, in later life there may be a sense of
chronic mistrust, dependency, depressive trends, withdrawal and shallow interpersonal

During the second year the child begins a struggle for autonomy. He shifts from
dependency on others towards independence actions of his own. As his musculature
matures, it is necessary for him to develop ability of coordination such as “holding on”
and “letting go”. Since these are highly opposing patterns, conflicts may occur. A power
struggle may develop between the child and his parents, since elimination is completely
under his control, and approval or disapproval becomes strong influences because of his
parent’s attitudes towards eliminative habits. The child is expected to abandon his needs
for self-gratification and substitute ones that meet the demands of his parents,
representing the later demands of society.

Cognitive development in this stage includes the first symbolic substitutions, words and
gross speech. The child begins to manipulate objects, he recognizes differences between
“I” and “me”, “mine” and “you” and “yours”. He also begins to manipulate others by
words such as “no” and the origin of concrete literal thinking are developed. This is the
period of preoperational thought that continues to the age of years. One of its
characteristics is egocentrism, which is replaced by social interactions by the end of this
period. The child has now formed concepts primitive images, thing to thing. He cannot
cope intellectually with problems concerning time causality, space or other abstract
concepts although he understands what each is by itself in concrete situations. His
perceptions dominate his judgments and he operates on what can be seen directly.

The psychological task during this stage is to develop self-esteem through limited self-
control. The achievement of bowel and bladder control within the prescribed cultural
expectations allow also for self-control without loss of self-esteem.

This is an important time for establishing a ratio between love and hate cooperation and
willfulness and freedom of self-expression and its suppression. Failure during this stage
is manifested in childhood by feelings of shame and doubt, fear of exposure and
ritualized activity; in later adulthood the failure to achieve ‘autonomy’ is seen in the
individual who is a “compulsive character”, with an irrational need for conformity and a
concomitant irrational need for approval.


Erikson (1963) believes that in the preschool stage the child has the task of developing
initiative. He will discover what kind of a person he is going to be, he learns to move
around freely and has unlimited radius of goals, his language skills broaden and he will
ask many questions. His skill in using words is not matched by his skills in understanding
them, and he thus faced with the danger of misinterpretation and misunderstanding
language and locomotion allow him to expand his imagination over such a broad
spectrum that he can easily frighten himself with dreams and thoughts.

The prerequisites for masculine and feminine initiative are developed. Initiative becomes
governed by a firmly established conscience. The child feels shame not only when he is
found out but also when he fears being found out; Guilt is felt for thought as well as
deeds, and in this stage anxiety is controlled by play, by fantasy, and by pride in the
attainment of new skills.

He/she is ready to learn quickly and to share and to work with others towards a given
goal; he/she begins to identify with people other than his parents and will develop a
feeling of equality of worth with others despite differences in functions and age.

If this stage is successfully accomplished, the child develops the fantasy of “I who can
become”, but if the child is excessively guilt-ridden, his fantasy is “I who shouldn’t
dream of it”. The desired self-concept at the end of this stage is “I have the worth to try
even if I am small.”

Failure or trauma at this time leads to confusion of psychosexual role, rigidity and guilt in
interpersonal relations, and loss of initiative in the exploration of new skills.


Prepuberty years are characterized as the learning stage. (Erikson, 1959). The child
develops a sense of industry in which he becomes dissatisfied if he does not have the
feeling of being useful or a sense of his ability to make things and make them well even
perfectly. He now learns to win recognition by producing things.

There is a slow but steady growth as maturation of the central nervous system continues.
In terms of psychosexual development there is reduced pressure in the exploration of
sensuality and the gender role while other skills are developed and exploited.

The cognitive phase of development includes the mastery of skills in manipulating

objects and the concepts of his culture. Thinking enters the period of concret operations
(Piaget, 1963) and the ability to solve concrete problems with this ability increases, so
that towards the end of this period the child is able to abstract problems. By puberty the
child exhibits simple deductive reasoning ability and has learned the rules and the basic
technology of his culture, thus reinforcing his sense of belonging in his environment.

Self-esteem is derived from the sense of adequacy and the beginning of “best”
friendships and sharing with peers. This also marks the beginning of the individual’s

friendships and love outside of his family, as he begins to learn the complexities,
pleasures and difficulties of adjusting himself and his drives, aggressive and erotic, to
those of his peers. Feeling of inadequacy and inferiority may begin if the child does not
develop a sense of adequacy.

In general, children are better able to cope with stress when normal familiar supports are
available. Any real or imagined threat of separation from a nuclear family member could
drastically reduce their abilities to cope with new or changing psychosocial demands.
They are particularly vulnerable to such crisis-precipitating situations as the loss of a
parent through death. Equally as stressful are recurring partial losses of a parent from the
child’s usual environment. An increasingly common source of emotional distress for
children of this age group is the entry, or re-entry, of the “homemaker” parent into the
work field.


Spending time with children is delightful. Their perspective of the world is very different
from the perspective of adults. Children view the world without the suspicion and
mistrust that many people acquire by the time they one adults.

To bring treating to a hurting child involves empathy and understanding of the children’s
world. Normal child development involves a series of cognitive, physical emotional and
social changes. These changes may be accompanied by stress or conflict which may lead
to learning behavior problems. A child counselor should therefore take time to consider
the nature of the child world.

One major goal for child counselor should be to provide a healing environment marked
by safety and stability of the child. Children are exposed to abuse, neglect, violence,
abduction, drugs and so many other unsafe activities thus making their world unsafe.
Children do not grow and progress when they do not feel safe.

No wander so many children and adolescents in our society are troubled. Children yearn
to be heard and that is why sometimes they make themselves “heard” through
inappropriate behaviouor. These behaviour lead to frustrations to the adults caused by not
understanding the child’s demands. When we enter the child’s world, we will be better
able to minister to them.

How to counsel children

There are two major methods of counseling children.

(i) Play therapy

(ii) Art/drawing therapy


Play therapy is a natural way for children to communicate and to act out sensitive
material related to frightening situations. Anna Freud theory state that play is used for
observational and diagnostic purposes only. She perceived play as best used to obtain
knowledge of children’s reactions, aggressive tendencies, and need for sympathy. Play in
child counseling is also used to get acquainted and establish rapport with children.

1. Active play therapy

In this play therapy children are a few selected toys by the therapist who then directs
them to act out certain traumatic scenes. It emphasized concrete problems which had
arisen at a specific time in child’s life. The therapist decides prior to therapy the nature of
the problem and orchestrated the play scene. The fundamental goal of this therapy is the
release of difficult emotions for example, fear and aggression, infantile pleasure and
sibling rivalry.

2. Passive play therapy

The therapist do not restrict children’s play. It emphasizes the acceptance of emotional
expression through ‘free therapy’. The therapist allows the children to play at their own
speed and to develop the direction and the limits of the play situation.

Importance of play therapy

Play therapy is unique since it employs the use of toys and games which children
naturally and universally find attractive and wants to be involved with. Play therapy
reduces the tension that often exists between therapist and client (children)

This play established the therapeutic relationship which encourages the children to use
their imagination and express feelings and behaviour which lead to the reduction of
anxiety and eventual problem resolution. Through play therapy children gain the security
and self-confidence necessary to express underlying emotions and to try out new ways of
thinking and behaving.

Play makes the children active learners. As children grow, much of the information to
receive and the skills they learn are obtained in social play activities.

The reasons for play therapy/values for play therapy.

(i) Play is a useful tool in establishing the therapeutic relationship.

(ii) Play assists the therapist as a diagnostic tool for understanding children.

(iii) Play helps relax children and it reduces anxiety, and defensive posturing
which enhances therapy.

(iv) Play encourages reluctant non-verbal clients to become involved with therapy.

(v) Play helps children to get out feelings about significant traumatic life
experiences in a safe environment.

(vi) Play provides children opportunities to develop social skills which may be
generalized to everyday behavior.


This is where a child is encouraged to draw something. It may be a person or whatever

the child feels like drawing, then ask the child to describe the drawing in various aspects.
Drawing helps children reveal what would not have been revealed through abstract
thinking. Pictures provoke the thought process and enact the likely communication.
Through drawing a child is able to talk about themselves without feeling threatened.

If a child colours using a particular colour, there is something particular with this colour
to the child. Let the child explain what they have drawn. Ask the children some questions
and discover what is in their mind.



This chapter explains the various causes of crisis in the family. It explains the
characteristic of the life events that cold lad to a family crisis, how crisis affects the
family, the coping behavior of a family in a crisis and how to prevent the crisis. The
chapter also explains some skills that an individual can use to cope with individual crisis.

Specific objectives

By the end of the chapter, the learner should be able to:

 Identify the characteristic of life events that could lead to a family crisis
 Explain how a crisis affects the family systems
 Recognize factors that help families prevents crises
 Evaluate family coping skills

Family crises, the event itself, the one-up effect, how crisis affect the family preventing a
crisis, coping with crisis, personal coping behavior.

Family crises

What brings on a crisis in the family?

Crises are experiences or events that cause people to make major changes in their lives.
A crisis usually happens when a family experiences so much stress that members are
unable to carry out regular functions. Stress is caused by life events that change or have
the potential to produce change in the family whether stress leads to a crisis depends on
the following four factors:

 The event itself

 Number of stressful events experienced at the same time
 How the family identifies and interprets the events
 Resources available to mange the stressful event

The event itself

Families experience many changes in life. Most of these changes are minor enough for
family members to deal with them. Missing the bus or being late for work are examples.
These changes are only stressful enough to motivate family members to take action.
They do not produce a crisis. The events that cause crises within the family are:

 Devastating events that cause a grate loss

Events that cause great losses are more likely to lead to crises than events that cause
small losses. A tornado that destroys the entire home is more likely to produce a crisis
than a hailstorm that break a window. An illness that results in death is more likely to
produce a crisis than a week’s long flu

 Very stressful events that widely impact members

Stressful event that affects several or all the members in a family is very likely to produce
a crisis. For example if the entire family relocates and tries to adjust to a new home, that
change could lead to a crisis.

 Sudden important event

A significant event that occurs unexpectedly is very likely to produce a crisis. A sudden
accidental death is more likely to lead to a crisis than deaths after long illness. When an
event is unexpected, the family has no time to prepare for the change. If they have no
previous experience with such a change, they often feel the situation is out of control.

 Events requiring major adjustments

Events that require little or no change are less likely to result in crisis than events that
require major adjustments. A divorce changes the family’s structures that are a major
change. The family that is a major change. The family will never again function just as
it once did. Such a change is likely to produce a crisis in the family.

The pre-up effect

Sometimes crisis result when several changes occur at the same time or one after another.
Each event in itself is too small to produce a significant loss. Each event may not affect
all the family members. The changes may be expected and occur slowly. Small changes
don’t have the characteristic of crises-producing pile-up effects. The end result is a crisis.
For example, the stress from poor grades on a west, an argument with a friend, conflict
with parents, and pressure from peer can all add up. The combined stress can result in a

How crisis affect the family

The family system becomes unbalanced when the family is functioning smoothly, it is
balanced. Each member carries out his or her roles. The family works together to meet
the needs of each member. The family is able to fulfill its functions in each member’s

In a crisis, one or more change disrupts this balance. Individual family members are
unable to fulfill their functions. Suddenly the family is not functioning smoothly as a
writ. The family needs time, resources and support as it works to adjust to the changes
and restore balance.

A loss affects family functions

In most crisis situations, some type of loss has taken place. The loss may involve a
family member, skills or abilities, a job, income or a home. A loss usually hinders the
family’s ability to fulfill its normal function at last for a period of time.

The family function of reproducing and socializing children is hindered by illness divorce,
hospitalization, or loss of family member. A job loss or a natural disaster could hinder
the family’s ability to meet physical needs. The family function of assigning roles may
be slowed by any crisis that prevents members from carrying out their roles. The
family’s ability to carry out the function of providing close relationships and intimacy
may be hindered by a death, divorce or move away from relatives.

When family members experience a loss, even though small they go through a grieving
process. When they are able to identify and accept their feelings, they will be able to
handle them and go on with their lives.

When a loss occurs, family members pass though certain motional stages. First they may
deny it then they often experience feelings of anger. This may be followed by feelings of
guilt to try, to try to get rid of the feelings of guilt they may blame other for the problem.
At this point, they may feel sorry for themselves. These feelings may lead to depression
such feelings are normal responses to a loss. However, they need to lead to an
acceptance of the reality of the loss. Acceptance is needed so family members can take
action and adjust to the change brought about the loss. If the family doesn’t adjust,
unhealthy behavior patterns may develop. Feelings of anger, blame and guilt will
continue. Members may feel depressed. When the family does not function normally,
the physical and mental health of members may suffer.

Responding to crisis with unhealthy behavior patterns may hinder the growth and
development of family members and cause serious long-term results. Developing skills
for preventing a family crisis is important for all family members.

Preventing a crisis

Family members who are prepared to adjust and handle stress – producing life events are
more likely to do so. They use the following methods to cope with the crisis:

 Identify sources of stress in the family

 Use outside resources to help handle the stress and its effects
 Foster good interaction skills with family members so they will cooperate in times of

Family members who have a positive attitude believe they can make a difference in their
situation. When life events produce changes, they believe in their ability to cope. They
look for ways to handle the stress and grow form the experience. Examining the family
situation and taking action to reduce s tress will keep the family in balance.

Coping with crisis

Even the most we will – prepared family will experience some rises-producing events
during the life cycle-chronic illness, the death of a loved one, drug or alcohol abuse,
criminal attacks, unemployment, and moving are types of crises many families face.

Often these events occur suddenly, without time for preparation. They will be
unexpected and inconvenient. Most likely, the family will not have prior experience
dealing with them. Sometimes these events intensity over a period of time without the
family realizing that such stressors could end in a crisis.

Family coping behaviors

When a crisis occurs, the family needs to use coming behavior; coping behavior is
planned behavior that helps the family adjust as quickly as possible to changes that have
taken the family can use the following behavior to cope with crisis:

 Understand the situation

 Seek solutions to the problem
 Strengthen the family unit
 Emphasize personal growth for individual family members

Coping behavior helps stabilize the family so it can again fulfill its functions within the
lives of family members. As family members take steps to identify and implement a
solution, they need an attitude of tolerance for each other. This is a growth process, and
growth takes time. It takes open lines of communication and flexibility to do whatever
needs to be done to cope with a crisis. It also takes a commitment from members to find
a solution that benefits everyone in the family.

In crisis the family’s own interactions can best the most valuable resource for coping.
Actions that encourage the growth of family members are more likely to succeed at
working together to solve problems.

Behavior of coping with crisis

Understand the situation:

 Ask what changes have taken or will take place

 Identify how the family is affected
 Use good communication skills

 Seek professionals who can provide information

Seek solutions to the problem

 Ask what can be done to handle the changes

 Keep a tolerant attitude
 Don’t blame others for the problem
 Avoid the use of drugs and alcohol as coping aids
 Be open and flexible
 Look for a solution that benefits all family members
 Identify available resources in the family and community

Strengthen the family unit

 Set aside quite uninterrupted times to talk

 Share thoughts and feelings openly
 Accept each other’s thoughts and feelings
 Encourage each other
 Take time for family leisure activities

Emphasize personal growth for individual family members

 Encourage all members to pursue individual interests

 Keep involved with friends and community
 Set goals for the future
 Make plans to reach personal and family goals

Personal coping behavior

High self-esteem, positive self-concept, and positive life attitudes can help you believe in
your ability to adjust. These qualities will help you look for ways to achieve personal
growth with each experience. Flexibility can help you make the adjustments. Your skills
for communication with others can help you build and maintain friendship.

Your personal management skills are also important resources. You can learn to mange
both your time and your money. The skill of making decisions can heel you find
solutions w hen problems arise. Your problem solving skills will lad you to community
and government resources that are available in times of crises.


Crisis is an experience or event that causes a person to make a change in his or her life.
As ingle life event or combination of events can cause a crisis in the family. When a
crisis occurs, the entire family is affected. As a result, it may not be able to carry out its
functions for sometime. Families can take steps to prevent a crisis. First, they can learn

to identify sources of stress, then they and learn to mange stress before a crisis develops.
Developing and using family resources can help them return balance to the family system
and about the negative effects of a crisis.

When a crisis does occur, family members need to use good coping skills. These skills
can help families adjust to changes so that the family can return to normal, meeting the
needs of its members.



This chapter explain crisis case handling. To understand crisis case handling, we shall
first clearly differentiate between crisis intervention and long term counseling and
psychotherapy. The chapter will also look at the telephone as crisis tool, case handling at
walk-in crisis facilities. We shall also look at confidentiality in case handling.

Specific objectives

By the end of this chapter, the learner should be able to:

(i) Distinguish between crisis intervention and long-term counseling and

(ii) Explain the reasons for use of the telephone to solve psychological problems.
(iii) Explain the telephone counseling strategies.
(iv) Explain the strategies for handling a disturbed caller.
(v) Explain the principle bearing on confidentiality.


Comparison of what crisis workers and long-term therapists do, case handling on
telephone crisis lines, case handling at walk-in crisis facilities, confidentiality in case

Comparison of what crisis worker and long-term therapists do

The radical difference between crisis intervention and long-term therapy is that in long
term therapy, problem definition, identification of alternatives and planning are much
broader in scope, more methodological and rely on continuous feedback loops to
ascertain effectiveness of intervention. In crisis intervention, problem exploration,
identification of alternatives planning and commitment to a plan are all much more
compressed in time and scope.

Whereas in long-term therapy a great deal of background exploration may provide the
therapist a panoramic view of client dynamics, the crisis workers, exploration typically is
narrow and starts and stops with the specific presenting crisis. The long-term therapist’s
view of alternative and planning a course of action commonly incorporate psycho
educational processes that seek to change residual, repressive and chronic client modes of
thinking, feeling and acting. The crisis worker seeks to quickly determine previous
coping skills and environmental resources available to the client and use them in the
present situation as a stopgap measure to gain time and provide a medium of stability in
an out-of-control situation.

A long term therapist would look towards a methodological manipulation of treatment
variable, assess these variables on a variety of dimensions, and process the outcome with
the client. A crisis worker often uses a “best-guess” based on previous experience with
what works and does not work with a particular problem.

Assessment and feedback of outcome measures in long-term therapy typically involve a

great deal of processing between client and therapist as to the efficacy of treatment.
Feedback and assessment in crisis intervention typically occur on a here and now basis,
with emphasis on what change have occurred in the previous minutes and what the client
will do in the next few hours.


The tremendous growth of “hotlines”, both in number and in geographical coverage

attests to the fact that people in crisis avail themselves of telephones to solve their
personal problems (Haywood & Leuthe, 1980). Typically, crisis phones lines are open 24
hours a day, 365 days a year whereas other specialized services may operate during
regular business hours. There are several reasons for the upsurge in use of the telephone
to solve psychological problems:

 Convenience
Telephones have become such an easy way of communicating that calling for
psychological assistance is a natural extension of “taking care of business” As in the case
of battering, most crises do not occur during normal business hours. When help is needed,
in a crisis, it is needed immediately.

 Anonymity.
Guilt, embarrassment, shame, self-blame, and other debilitating emotions make face-to-
face encounters with strangers very difficult. Particularly in the immediate aftermath of a
traumatic event. Telephone counselors understand that clients have such feelings and are
generally not concerned is involved. Conversations are usually on a first-name only basis
for both the worker and the client.

 Control
A great deal of fear, anxiety and uncertainty occur when a client’s life is ruptured by a
crisis. The concept of secondary victimization by institutions is well known to victims of
a crisis who have sought assistance from a social agency and then have been victimized
by its bureaucratic cautiousness. In telephone counseling the client decides when and if to
seek further assistance.

 Immediacy of access
When using a telephone to seek for help, a client is sure of an immediate reply.
Nowadays telephones are available all over and even some institutions use pagers.

 Cost effectiveness
Crisis lines are inexpensive-both for the client and the community. Clients who cannot
pay for private therapy or afford transportation can usually avail themselves of a phone.
Most community agency hotlines are staffed by volunteers.

 Access to support systems

Support groups make extensive us of telephones networks. Telephone support networks
have provided constant links to group members between organized meetings.

 Avoidance of dependency issues.

Dependence on a particular human services worker who may not be readily available is
negated by telephone crisis lines. Standard practice in most crisis lines discourages
workers from forming lasting relationships with clients so that dependency issues do not

 Availability of others for consultation

Crisis lines are seldom staffed by one person, when a difficult client is encountered,
others staff at the agency are available for consultation. Furthermore at least one phone
line is reserved for calling support agencies when emergency services are needed.

 Availability of an array of services

A vast array of information, guidance and social services is quickly available via
telephone linkages. The specialized services of different agencies and the expertise they
offer can provide on the spot guidance for emotionally volatile situations.

 Service to large and isolated geographical areas

Many rural areas that have no after-hours mental health facilities or staff are tied into 500
– number crisis lines that cover huge geographical areas. These crisis line in turn are tied
into emergency service staff such as police, paramedics, and hospital emergency rooms
that serve those rural areas and can respond to a crisis line call for assistance that may be
150 miles away.


Conducting crisis intervention over the telephone is a double-edged sword. Although

phone counseling offers the advantages listed above, the crisis worker is entirely
dependent on the content, voice tone, pitch, speed and emotional content of the client in
generating responses. For many human services workers, it is unsettling to deal with
ambiguous client responses and not be able to link body language to verbal content.
Further, the worker is entirely dependent on his/her own verbal ability to stabilize the
client and has little physical control over the situation. A great deal of care and effort
needs to be taken in responding to clients.


Making psychological contact

First, psychological contact needs to be made, and this endeavor takes precedence over
anything else the phone worker does. Psychological contact means that the worker
attempts to establish as quickly as possible a non judgmental, caring, accepting and
empathic relationship with the client that will give the worker credibility and elicit the
clients trust. It is safe to assume that people who use crisis lines have exhausted or are
separated from their support systems. It is a most point that the crisis worker can make an
astute dynamic analysis, synthesize material, diagnose the problem, and prescribe a
solution if the client feels no trust in the relationship and hangs up the phone. In
establishing psychological contact on the phone, providing support is a first priority and
is highly integrated with defining the problem through active listening and responding

The phone worker must be able to react in a calm and collected manner. Thus, the
workers voice must be well modulated, steady, low-keyed with an adequate decibel level,
but not high pitched. The content of the worker’s response should not be deprecating,
cynical, cajoling or demeaning.

 Defining the problem

Once psychological contact is established, the worker attempts to define the problem by
gaining an understanding of the events that led to the crisis and assessing the clients
coping mechanisms. Open-ended questions on the what, how, when, where, who,
continuum usually enable the worker to obtain a clear picture of the event itself. However,
in assessing the coping mechanisms of the client in a phone dialogue, it may be difficult
for the worker to obtain a clear picture of the affect of the client. One of the real pluses of
phone counseling is that the beginning crisis worker can have supportive aids readily at
hand without detracting from the counseling session. One useful tactic is to have a
reference list of feelings words that cover the gamut of emotions. Another tactic is to
have at hand a list of standard questions the counselor can check off to be sure that all
areas typically pertinent to the problem are covered. Another tactic is to keep handy a
notepad on which the worker can jot down the silent aspects of the event and coping
mechanisms the client has employed and make a rapid assessment.

 Ensuring safety

During problem definition, the phone worker must be very specific in determining the
client’s lethality level. If the worker defects the potential for physical injury, then closed-
ended questions that obtain information specific to the safety of the client should be
asked, and these should be asked not only without hesitation but also with empathic
understanding that clearly depicts the worker’s overriding concern and valuing of the
client. These questions typically start with do, have, and are in phone dialogues they
should be put directly and assertively to the client.

 Making plans
Creating alternatives and formulating a plan are integral to one another in any crisis
situation but are even more closely tied together in phone counseling. To alleviate the
immediate situational threat, the phone counselor needs to jointly explore alternatives that
are simple and clear-cut. Without the benefit of an eye witness view or an in-depth
background of the client, the worker needs to be cautious about proposing alternatives
that may be difficult to carry out due to logistical or tactile problems of which the worker
is unaware. Alternatives need to be explored in slow, stepwise manner with checks by the
worker that the client is able to do the physical and psychological work necessary to
complete the task. Role play verbal rehearsal and recapitulation of objectives by the client
are vital ingredients of a functional plan. No plan should be accepted until the client can
reassure the worker that he/she thoroughly understands the plan and has the means to put
it into action.

 Obtaining commitment
Commitment to a plan of action generated over the phone should be simple, specific, and
time limited. If at all possible, the worker should attempt to obtain the client’s phone
number and call the client back at a present time to check on the plan or, if the agency
accepts walk-in-clients, the worker should attempt to have the individual schedule an
appointment as soon as possible. If the worker is linking with other agencies, then a
phone call should be made to the referral agent to check whether the client has completed
the task. Although it is preferable to have the client take the initiative in contacting other
agencies so that dependence on the worker is not created. It may be that conditions
prohibit the client from doing so. In that case, the worker should have no hesitation in
offering to make the call.

Understand the regular caller’s agenda

Helping people in crisis is different from being nice to them. The agenda of regular
callers places the crisis worker in a dilemma. Regular callers may tend to be placed in a
stereotypical catchall category because they represent an aggravation to the crisis line.
However, the reasons these individuals call are diverse. Identification of specific types is
at least as important as identifying the specific caller. Below is a brief description of
some of the more typical personality disorders of regular callers, their outward behaviour,
inner dynamics and strategies for counseling them.


Paranoid are guarded, secretive and can be pathologically jealous. They live in logic-tight
compartments and it is difficult if not impossible to shake their persecutory beliefs. They
see themselves as victims and expect deceit and trickery from everyone. The counseling
focus is to stress their safety needs.


Schizoid have extremely restricted emotional expression and experience. They have few
social relationships and feel anxious, shy, and self conscious in social settings. They are
guarded, tactless, and often alienate others. The counseling focus is to build a good sense
of self-esteem through acceptance, optimism and support.


Schizotypals have feelings of inadequacy and insecurity. They have strange ideas,
behaviours and appearance. The focus of counseling is to give them reality checks and to
promote self-awareness and more socially acceptable behaviour in a slow paced,
supportive manner.


Antisocials use others, cannot relate to the needs of society or its rules and regulations
and behave in relation to their own self-gratification with little if any thought of the
welfare of others. These clients call only when they are in serious personal trouble. The
focus of counseling is to get them to assume responsibility for their behaviour and the
very real and personal consequences their behaviour will undoubtedly incur.


Narcissistic are grandiose, extremely self-centered, and believe they have unique
problems that others cannot possibly comprehend. They see themselves as victimized by
others and always have the need to be right. The focus of counseling is to get them to see
how their behaviour is seen and felt by others while not engaging in a “no win” debate or
argument with them.


Histrionic move from crisis to crisis. They have shallow depth of character and are
extremely ego involved. They crave excitement and become quickly bored with routine
and mundane tasks and events. They may behave in self-destructive ways and can be
demanding and manipulative. The focus of counseling is to stress their ability to survive
using resources that have been helpful to them in the past.


Dependents have trouble making decisions and seek to have others do so often times
inappropriately. Feelings of worthlessness, insecurity and fear of abandonment
predominate. They are particularly proved to become involved and stay in self-
destructive relationships. The focus of counseling is reinforcing strengths and acting as a
support for their concern without becoming critical of them or accepting responsibility
for their lives.


Self-defeating types choose people and situations that lead to disappointment failure, and
mistreatment by others. They reject attempts to help them and mlake sure that such
attempts will not succeed. The focus of counseling is stressing talents and the behavioral
consequences of sabotaging themselves.

Obsessive compulsive

Obsessive-compulsive are preoccupied by and fixate on task. They expend and waste vast
amounts of time and energy on those endeavors. They often do not hear counselors due to
utile attempts to obtain self control over their obsessions. The focus of counseling is to
establish the ability to trust others and the use of thought stopping and behaviour
modification to diminish obsessive thinking and compulsive behavior.


Avoidant types are loners who have little ability to establish or maintain social
relationships. Their fear of rejection paralyzes their attempts to risk involvement in social
relationships. The focus of counseling is encouragement of successive approximations to
meaningful relationships through social skills and assertion training.

Passive –aggressive

Passive-aggressive cannot risk rejection by displaying anger in an overt manner. Rather,

they engage in covert attempts to manipulate others and believe that control is more
important than self-improvement. The focus of counseling is to promote more open,
assertive behaviour.

Given the preceding personality disorders and their agendas. The admonition is still to
treat these clients not as types, but as individuals with their own idiosyncratic problems.

Handling the disturbed caller

The behaviour of the severely disturbed is primitive, disorganized, disoriented and

disabling. These people are likely to elicit discomfort, anxiety, and outright fear in the
observer. The following are rules for dealing with disturbed callers, abstracted from a
number of crisis hotlines.

Slow emotions down

Although disturbed callers have many feelings that have been submerged from awareness,
it is not the best strategy to attempt to uncover these feelings. The caller is being besieged
by too many feelings and needs to find a way to get them in control. Focusing on there
and now issues that are concrete and reality oriented is the preferred mode of operation.
Do not elicit more feelings with open ended questions. Instead, use calming interventions
that force the person to order thinking in small, realistic bits of detail.

Refuse to share hallucinations and delusions

If a caller is hallucinating or delusional, the telephone worker should never side with the
psychotic ideation. Asking a when question helps the worker to start eliciting information
that will allow for an assessment of the cope and extent of the paranoia. A why question
is never appropriate because of the defensive reaction it may elicit in any caller and
especially in a paranoid.

Determine medication usage

If at all possible the worker should attempt to elicit information as to the use of any
medication, amount and time of dosage, and particularly discontinuance of the
medication without consulting the attending physician. Changing, forgetting, or
disregarding medication is one of the most common reasons that individuals become
actively psychotic. Having this information will give the worker a better idea of the type
of mental disturbance the caller is being treated for.

Keep expectations realistic

The telephone worker should keep expectations realistic. The caller did not become
disturbed overnight. No crisis worker is going to change chronic psychotic behaviour
during one phone call. The crisis worker is buying time for the caller in a period of high
anxiety and attempting to restore a minimum amount of control and contact with reality.
If the caller is trying to “milk” the worker through an intermitiable conversation,
confronting the problem in a direct manner will generally determine whether the caller is
lonely or is in need of immediate assistance.

Maintaining professional distance

Calls from severely disturbed individuals may evolve all kinds of threatening feelings in
phone workers, leaving them feelings inadequate confused, and in crisis themselves.
Maintaining professional distance when exceedingly painful and tragic stories are related
is difficult for the most experienced phone workers. When these feelings begin to emerge
it is of utmost importance for workers to make owning statements about their own
feelings and get supervision, immediately passing the line to another worker in no way
indicates inadequacy.

Avoid placating

Placating and sympathizing do little to boster the callers confidence or help move the
client toward action. Rather by empathically responding and exploring past feelings and
coping skills when life was better, the telephone worker not only acknowledges the
dilemma but also focuses on the clients strength.

Assess lethality

Many client who call crisis lines have active suicidal or homicidal ideation. By calling
the crisis workers, the clients as trying to put distance between their thoughts and the
actions that might result from those lethal thoughts. As much as the caller may avow
intentions of lethality, they are still in enough control of themselves to attempt to place a
buffer between thinking and acting. The major goal of the crisis worker is to disrupt the
irrational chain of thinking that is propelling the client towards violence.


Unlike contact with the faceless and anonymous telephone clients, crisis worker contact
with walk-in-clients in close-up and personal clients who present themselves for crisis
counseling at walk in facilities generally fall within one of four categories.

 Those who are experiencing chronic mental illness

 Those who are experiencing interpersonal problems in their social environment.
 Those who are experiencing interpersonal problems in their own development.
 Those who are experiencing a combination of the three foregoing categories.


Confidentiality indicates an explicit promise or contract to reveal nothing about an

individual except under conditions agreed to by the source or the subject. Privileged
communication is designed to protect confidential information from disclosure in the area
of legal proceedings. Three important principles have a bearing on the issue of
confidentiality they involve the legal, ethical and moral codes of the helping profession.

Legal principles

Legally the clients of certain professionals have the right of confidentiality through
privileged communication. Depending on the type of setting and the geographic locale in
which they practice, human services workers have varying degrees of privileged
communication in the eye of law.

Ethical principles

Ethical standards are general guiding codes of conduct for a particular profession.
Standard professional conduct and reasonable level of care dictates that what is said in
confidence remain so.

Moral principles

When one shares problems of a deeply personal nature, common decency dictates that the
recipient should keep the confidence of the individual who shares such information.

In all crisis work, client confidentiality is a moral, ethical and sometimes legal
requirement. In many instances, crisis workers are faced with the possibility of violent
behaviour and the need to ensure the safety of clients and significant others. Therefore,
when clients disclose an intent to do harm either to themselves or others, the crisis worker
has a moral, ethical and legal duty to take action, break confidentiality and warn intended
victims, significant others or legal authority.


This chapter has discussed crisis case handling and has dwelt more on the case handling
through telephone communication. The chapter has outlined and explained the reasons
for prevalence in using telephone to solve crisis and the strategies or crisis intervention
vice the telephone. The issues presented in the walk-in crisis facilities have been mention
and the principles of confidentiality.



This chapter explains crisis intervention, the goals of crisis intervention, the approaches
to crisis intervention and the steps in crisis intervention. It also gives the philosophical
orientation necessary for the full effectiveness of a crisis worker.


By the end of the chapter the learner should be able to:

 State the goals of crisis intervention.

 Explain the approaches to crisis intervention

 State the philosophical orientation of an effective crisis worker

 Explain the steps in crisis intervention


Goals of crisis intervention, approaches of crisis intervention (methodology)

philosophical orientation of crisis worker, steps in crisis intervention.


Crisis intervention extends logically from brief psychotherapy. The minimum

therapeutic goal of crisis intervention is psychological resolution of the individual’s
immediate crisis and restoration to at least the level functioning that existed before the
crisis period. A maximum goal is improvement in functioning above the precrisis level.
Caplan emphasis that crisis is characteristically self-limiting and lasts from 4 to 6 weeks.
The constitutes a transitional period, representing both the danger of increased
psychological vulnerability and an opportunity for personality growth. In any particular
situation the outcome may depend to a significant degree on the ready availability of
appropriate help. On this basis the length of time for intervention is from 4 to 6 weeks,
with the median being 4 weeks (Jacobson, 1965).


Jacobson and associates (1968, 1980) state that crisis intervention may be divided into
two major categories, which may be designated as generic and individual.


A leading proposition of the generic approach is that there are certain recognized patterns
of behaviour in most crisis.

The generic approach focuses on the characteristic courses of the particular kind of crisis
rather than on the psychodynamics of each individual in crisis. A treatment plan is
directed towards an adaptive resolution of the crisis. Specific intervention measures are
designed to be effective all members of a given group rather than for the unique
difference of one individual. Recognition of these behaviour patterns is an important
aspect of preventive mental health.
Jacobson and associates (1968) state that generic approaches to crisis intervention include
“direct encouragement of adaptive behaviour, general support, environmental
manipulation and anticipatory guidance……in brief the generic approach emphasis.
 Specific situational and maturational events occurring to significant population groups.

 Interventions oriented to crisis related to those specific events.

 Intervention carried out by non non-mental health professionals.

The approach has been found to be a feasible mode of intervention that can be learned
and implemented by non psychiatric physicians since it does not require a mastery of
knowledge of the intrapsychric and interpersonal process of an individual in crisis.


The individual approach differs from the generic in its emphasis on assessment by a
professional, of the interpersonal and intrapsychic processes of the person in crisis. It is
used in selected cases, usually those not responding to the generic approach. Intervention
is planned to meet the unique need of the individual in crisis and to reach a solution for
the particular situation and circumstances that precipitated the crisis. This differs from
the generic approach, which focuses on the characteristic course of a particular kind of

Morley and associates (1967) recommended several attitudes that are important adjuncts
to the specific techniques. These comprises the general philosophical orientation
necessary for the fully effectiveness of the therapist.
 It is essential that the therapist view the work being done not as a “second-best” approach
but as the treatment of choice with person in crisis.

 Accurate assessment of the presenting problem, not a thorough diagnostic evaluation, is

essential to an effective intervention.

 Both the therapist and the individual should keep in mind throughout the contact that the
treatment is sharply time limited and should persistently direct there energies towards
resolution of the presenting problem.

 Dealing with material not directly related to the crisis has no place as an intervention of
this kind.

 The therapist must be willing to take an active and sometimes directive role in the

 Maximum flexibility of approach is encouraged. Such diverse techniques as a resource
person or information giver and taking an active role in established liaison with other
helping resources are often appropriate in particular situations.

 The goal towards which the therapist is striving is explicit. His energy is directed entirely
towards returning the individual to at least his precrisis level of functioning.


There are certain specific steps involved in the technique of crisis intervention (Morley and
associates, 1967). Although each cannot be placed in a clearly defined category, typical
intervention would through the following sequence of phase.

1. The first phase is the assessment of the individual and his problem. This requires the use
of active focusing techniques on the part of the therapist to obtain an accurate assessment
of the precipitating event and the resulting crisis that brought the individual to seek
professional help. The therapist may have to judge whether the help seeking person
presents a high suicidal or homicidal risk. If the patient is thought to be a high level of
danger to himself or to others, referral is made to a psychiatrist for consideration or
hospitalization. The initial hour may be spent entirely on assessing the circumstances
directly relating to the immediate crisis situation.

2. Planning of therapeutic intervention.

After accurate assessment is made of the precipitating event(s) and the crisis intervention is
planned. This is not designed to bring about major changes in the personality structure but to
restore the person to at least his precrisis level of equilibrium. In this phase determination is
made of the length of time since onset of the crisis. The precipitating event usually occurs
from 1 to 2 weeks before the individual seeks help. Frequently it may have occurred within
the past 24 hours. It is important to know how much the crisis has disrupted the individual’s
life and the effects of this disruption on others in his environment. Information is also sought
to determine what strength the individual has, what coping skills he may have used
successfully in the past and is not using presently, and what other people in his life might be
used as support from him. Search is made for alternative methods of coping that for some
reason he is not presently using.

3. Intervention

The nature of intervention techniques is highly dependent on the preexisting skills, creativity,
and flexibility of the therapist. Morley suggests the following.

(a) Helping the individual to gain an intellectual understanding of his crisis. Often individual
sees no relationship between a hazardous situation occurring in life and the extreme
discomfort of disequilibrium that he is experiencing. The therapist could use a direct
approach, describing to the patient the relationship between crisis and the event in his

(b) Helping the individual bring into the open his present feelings to which he may have
access. Frequently the person may have suppressed some of his feelings which are very
real, such as anger or other inadmissible emotions towards some one. An immediate goal
of intervention is the reduction of tension by providing means for the individual to
recognize these feelings and bring them into the open. It is sometimes necessary to
produce emotional catharsis and reduce immobilizing tension.

(c) Exploration of coping mechanisms.

This approach requires assisting the person to examine alternative ways of coping. If for
some reason the behaviour he used in the past for successfully reducing anxiety have not been
trid, the possibility of their use in the present situation is explored. New coping methods are
sought and frequently the person devises some highly original methods that he had never
tried before.

d) Reopening the social world. If the crisis has been precipitated by loss of someone
significant to the person’s life the possibility of introducing new people to fill the void can be
highly effective. It is particularly effective if support and gratification provided by the “lost”
person in the past can be achieved to a similar degree from new relationships.

4. The last phase is the resolution of the crisis and anticipatory planning. The therapist
reinforces those adaptive coping mechanisms that the individual has used successfully to
reduce tension and anxiety. As his coping abilities increase and positive changes occur, they
may be summarized to allow him to reexperience and reconfirm for himself the progress he
has made. Assistance is given as needed in making realistic plans for the future, and there is
discussion of ways in which the present experience may help in coping with future crises.


Even though human crises are never simple, crisis workers need to have a relatively
straightforward and efficient model of intervention. The six-step model provides the straight
forward approach to crisis intervention. The model has been used by both professional
counselor and lay workers in helping clients with many different kinds of crisis. It is
situationally based method of crisis intervention and is preferred for systematically apply
several worker-initiated skills.

Step 1: Defining the problem

The first step in crisis intervention is to define and understand the problem for the client’s
point of view. Unless the therapist perceives the crisis situation as the client perceives it, all
the intervention strategies and procedures he might use may miss the mark and be of no value
to the client. Throughout the crisis intervention process, workers direct their listening and
acting skills according to the dictates of the definition. As an aid to defining crisis problems,
crisis workers need to practice the core listening skills: empathy, genuineness and acceptance
or positive regard (Cormier and Cormier, 1991).

Step 2: Ensuring client safety

It is imperative that crisis workers continually keep client safety at the forefront of all crisis
intervention procedures. Client safety is simply defined as minimizing the physical and
psychological danger to self and others. Safety is a primary consideration throughout crisis
intervention. The dimension of safety receives equal consideration in the worker’s assessing,
listening and acting strategies.

Step 3: Providing support

This step emphasizes communicating to the client that the worker is a person who cares about
the client. Workers cannot assume that a client experiences feeling valued, prized or cared
for. The support step provides an opportunity for the worker to assure the client that “here is
one person who really cares about you”

The worker is the person providing the support and so he must be able to accept, in an
unconditional and positive way, all their clients whether the client can reciprocate or not. The
worker who can truly provide support for clients in crisis is able to accept and value the
person no one else is willing to accept and to prize the client no one else prizes.

Step 4: Examining Alternatives

This step addresses the area of exploring a wide array of appropriate choices available to the
client. Many times clients, in their immobile state do not adequately examine their best
options. In this step, effective workers help clients recognize that many alternatives are
available and that some choices are better than others. It may help for workers to realize that
there are different ways to think about alternatives.

i. Situational support which are excellent sources of help, are people known to
the client in the present or past who might care about what happens to the

ii. Coping mechanisms are those actions, behaviours or environmental resources

the client might use to help get through the present crisis.

iii. Positive and constructive thinking patterns on the part of the client are way of
thinking that might substantially alter the client’s view of the problem and
lessen the client’s level of stress and anxiety.

The effective crisis worker may think about an infinite number of alternatives pertaining
to the clients crisis but discuss only a few of them with the client.

Step 5: Making plans

This stop follows logically and directly from step 4. This stage focuses on workers
involvement with clients in planning action steps that have a good chance of restoring the
clients emotional equilibrium. A plan should;

(i) Identify additional persons, groups and other referral resources that can be
contacted for immediate support.

(ii) Provide coping mechanisms – something concrete and positive for the client to
do now, definite action steps that the client can own and comprehend. The plan
should focus on systematic problem solving for the client and be realistic in
terms of the clients coping ability.

It is important that planning be done in collaboration with clients so that clients feel a
sense of ownership of the plan. The critical element in developing a plan is that the client
do not feel robbed of their power, independence, and self respect. The central issue in
planning are client’s control and autonomy. The reasons for clients to carry out plans are
to restore their sense of control and to ensure that they do not become dependent on
support persons such as the worker.

Step 6: Obtaining commitment

The issue of control and autonomy apply equally to the process of obtaining an
appropriate commitment. If the planning step is effectively done, the commitment step is
apt to be easy. Many times, the commitment step is brief and simple, consisting of asking
the client to verbally summarize the plan.

During this step the crisis worker demonstrates responsibility in carrying out his/her part
of the plan if a collaboration has been agreed on. The worker at this step does not forget
about other helping steps and skills such as assessing, ensuring safety and providing
support. The worker is careful to obtain an honest, direct and appropriate commitment
from the client before terminating the crisis intervention session. Later, when the worker
checks up on the client’s progress, the checking is done in an empathic and supportive


Clinbell, H. (1984). Basic Types of Pastoral Care and Counselling. Nashville: Abrigdon



Aguilero, D. C. and Messick, J. M. (1982). Crisis Intervention: Theory and Methodology

(4th Ed). St. Louis: C.V. Mosby.

Gilliland, B. E. and James, R. K. (1988). Crisis Intervention Strategies (3rd Ed). Pacific

Grove CA: Brooks / Cole Publishers.

James, R. K. and Gilliland, B. E. (1991). Future Directions of Crisis Intervention. Pacific

Grove CA: Brooks/Cole Publishers.

James, R. K. (1994). The Family of Schizophrenia. New York: Puttmann and Sons.

Nelson, R. and Slaikeu (1990). Crisis Interventions in Schools: A Handbook of Practice

and Research. Boston: Allyn and Bacon

Robert, A. R. (1991). Contemporary Perspectives on Crisis Interventions., Eaglewood

Cliff, New Jersey: Prentice Hall.

Talbot, A. ,Manton, M. and Dunn, P. J. (1995). Debriefing the Debriefers: An

Intervention Strategy to Assist Psychologists After a Crisis. New York: Plenum Press.

Young, M. A (1991). Crisis Intervention and the Aftermath of Disaster. Eaglewood Cliff,

New Jersey: Prentice Hall.